Therapy for angina pectoris: comparison of nicardipine with other antianginal agents.

Nicardipine is a new dihydropyridine calcium channel blocking drug with actions that suggest considerable usefulness as an agent for chronic stable angina. Hemodynamic studies in patients with coronary artery disease confirm major coronary vasodilator actions, perhaps even exceeding its considerable systemic vasodilator properties with little or no negative inotropic effect. Three recent controlled clinical trials that used nicardipine alone suggest approximately 20% to 30% increase in exercise time, and at least that much decrease in anginal episodes and sublingual nitroglycerin consumption when compared with placebo in doses of 90 to 120 mg daily. Five trials comparing nicardipine with other calcium channel blockers, and three with beta blockers, suggest equivalent efficacy, including decrease in angina and increase in exercise time. Adverse effects of nicardipine generally relate to its potent vasodilatory capability and are usually minor. Side effects are frequent at the beginning of many trials, usually do not cause undue withdrawals, and are quite rare after 6 to 12 months on the drug in most studies.